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Abstract

Introduction: Blood pressure (BP) screening is routine practice during outpatient care, yet the prevalence of uncontrolled hypertension is 14% in the U.S. The aim of this study was to examine race/ethnic differences in BP status using a large outpatient electronic health record (EHR) registry.

Methods: Outpatient EHR data were analyzed from The Guideline Advantage™ (TGA), a joint quality improvement initiative of the American Heart Association, American Diabetes Association, and American Cancer Society. Data were compiled from patients aged ≥18 years seen at >70 individual clinics across the U.S. Logistic regression was used to examine the differences in BP control status at the most recent outpatient visit.

Results: We observed 2,096,253 BP measurements among 276,452 patients (mean = 8 per patient). The population was 43% male with a mean age of 50 years. Overall, 20% of patients had BP ≥ 140/90 mmHg and this proportion differed by race/ethnic group (Figure). Among patients not on BP medication, non-Hispanic Blacks had 2.41 times the odds of BP ≥ 140/90 mmHg compared to non-Hispanic Whites [aOR(95%CI): 2.41(2.32-2.50)]; no differences were observed for Asians and Hispanics/Latinos compared to the reference group (p=0.49 and 0.30, respectively). Among those on BP lowering agents, non-Hispanic Blacks were at 96% higher odds of uncontrolled BP compared to non-Hispanic Whites [aOR: 1.96(1.15-3.34)] and Hispanics/Latinos had 2.58 times the odds of uncontrolled BP compared to non-Hispanic Whites [(aOR: 2.58(1.44-4.62)].

Conclusions: The proportion of patients with uncontrolled or poorly controlled BP differed by race/ethnicity. Additional investigation to identify underlying patient- and provider-level factors contributing to this observed disparity will be particularly important moving forward for accountable care organizations to meet metrics for quality care equitably across patient subgroups, including diverse race/ethnic populations.